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<head>
<title></title>
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<body>



<br>
<b>Get a beta merchant account for free . . .</b>
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<br>
$content
<form name=reg method="post" action="">
<table>
	<tr>
		<td>&nbsp;</td>
		<td>Name</td>
		<td><input type=text value="$username" name=username></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td>Password</td>
		<td><input type=password name=passwd></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td>Confirm Password</td>
		<td><input type=password name=cpasswd></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td>E-mail</td>
		<td><input type=text name=email value="$email"></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td>Telephone</td>
		<td><input type=text name=tel value="$tel"></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td valign=top>Contact Postal Address</td>
		<td><textarea name="addr">$addr</textarea></td>
	</tr>
	<tr>
		<td>&nbsp;</td>
		<td>&nbsp;</td>
		<td><input type=submit value=Register name=action></td>
	</tr>

</table>
</form>


27th September
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